Health Column: Managing Medicare drug coverage

10/04/2010 4:29 PM |

Dear Marci,
I am going to turn 65 in a month, and have drug coverage through my employer’s plan. Should I enroll in Part D?
Kurt

Dear Kurt,
It depends. If you have drug coverage from a current or former employer or union, you should consider the quality of your employer coverage and whether or not it will work with the Medicare drug benefit. It often will not.
If you have coverage that is as good as or better than Medicare’s drug benefit (“creditable”) and you like it, you can keep it. You will not pay a penalty to join a Medicare private drug plan later as long as you have not been without your creditable coverage for more than 63 days. Find out from your employer whether your coverage is as good as Medicare’s drug benefit. You should get a notice from your employer every year letting you know how your employer benefits are changing, whether or not your drug coverage is creditable, and if enrolling in a Part D plan would affect your current coverage (for both you and your family members who receive that coverage).
If you want to keep your employer benefits, and are considering joining a Medicare drug plan, make sure you ask your employer if you can have both types of coverage. Many employer plans do not work with the drug benefit. You could lose all your employer benefits — both health and drug — if you join a Medicare private drug plan.

Dear Marci,
Will Medicare pay for substance abuse treatment?
Lorrie

Dear Lorrie,
Yes. Medicare will help pay for substance abuse treatment in both inpatient and outpatient settings under the following conditions:
• You receive services from a Medicare-participating provider or facility;
• Your doctor must state that the services are medically necessary; and
• Your doctor determines your treatment plan.
Substance abuse treatment is classified under mental health services. For substance abuse treatment, Medicare will pay 55 percent of its approved amount for mental health services, and you or your supplemental insurance are responsible for the rest.
For inpatient care, Medicare Part A helps pay for your care if you are hospitalized for substance abuse treatment. Your out-of-pocket costs are the same as for any other type of hospital stay.
For outpatient care, Medicare Part B helps pay for outpatient substance abuse treatment services from a clinic or hospital outpatient department. Covered services include, but are not limited to: psychotherapy; patient education regarding diagnosis and treatment; post-hospitalization follow-up; and prescription drugs administered during a hospital stay or injected at a doctor’s office.

Dear Marci,
What is a Federally Qualified Health Center? A friend suggested I look into them because of my limited income.
Marylou

Dear Marylou,
Federally Qualified Health Centers are located in “medically under-served areas” and provide low-income health care. People with Medicare are eligible to receive services from these government-funded health centers. They provide Medicare-covered medical services as well as some preventive services that Medicare doesn’t cover, and they may also waive the Medicare Part B deductible. Additionally, the clinics may waive or reduce the 20 percent coinsurance for Medicare-covered benefits for people with an annual income at or below the federal poverty level ($10,830 for an individual, $14,570 for a couple in 2010). Some government-funded health centers may also provide dental services.

Marci’s Medicare Answers is a service of the Medicare Rights Center (www.medicarerights.org), the nation’s largest independent source of information and assistance for people with Medicare.

26 Comment